A comprehensive review published in The BMJ suggests that calcium supplements, vitamin D supplements, or taking both together provide little or no clinically significant benefit in preventing fractures or falls in most older adults.
Falls are a major health problem among older people. Nearly one in three people aged 65 and older suffers a fall each year, and many of these incidents result in fractures. These injuries can lead to pain, reduced independence, reduced quality of life, and in some cases, the need for long-term residential care. As populations age, preventing falls and fractures remains an important public health goal worldwide.
Previous reviews have already raised questions about the effectiveness of calcium and vitamin D supplements. In general, research has found no reduction in fracture risk with either supplement alone, while results from taking both together have been mixed. The role of vitamin D in reducing falls also remains uncertain.
Still, health care providers, professional guidelines, and bone health regulatory agencies continue to widely recommend vitamin D supplements (with or without calcium). Prescriptions for these supplements have also increased considerably in recent years.
Analysis of 69 clinical trials
To better understand the evidence, researchers in Canada analyzed data from 69 randomized controlled trials involving 153,902 adults. The studies compared calcium supplements, vitamin D supplements, or a combination of both with placebo or no treatment to determine whether they reduced the risk of falls and fractures.
Although the quality of the trials varied, researchers assessed each study using established methods to assess both potential bias and the certainty of the evidence.
After setting thresholds for what would qualify as a clinically significant benefit, the team found little or no reduction in overall fracture risk with calcium supplements (moderate-certainty evidence from 11 trials; 9,067 participants), vitamin D supplements (high-certainty evidence from 36 trials; 92,045 participants), or combination supplementation (high-certainty evidence from 15 trials; 51,126 participants).
The analysis also showed little or no benefit in preventing specific fractures, including hip fractures, or in reducing falls. These findings were largely supported by moderate to high-certainty evidence.
Findings hold across different groups
The researchers note that some parts of the analysis included relatively few studies and participants. As a result, the findings should be interpreted with caution. They also caution that the results may not apply to people with certain bone disorders or those receiving medications for osteoporosis.
However, additional analyzes produced similar results even after taking into account factors such as age, sex, previous fractures, previous falls, and average calcium intake from food. According to the researchers, this consistency strengthens confidence in the general conclusions.
Based on the available evidence, the authors conclude that the findings “do not support routine supplementation with calcium or vitamin D, nor combined supplementation to prevent fractures and falls.”
They further suggest that physicians, guideline panels, and regulatory agencies “should reevaluate their general recommendations for calcium and vitamin D supplementation in light of current evidence.”
Focus can shift to proven fall prevention strategies
In a linked editorial, the researchers say more rigorous and powered clinical trials are needed to guide recommendations for people who may face a higher risk of fractures or falls.
Until then, they argue that it is best to direct resources and funding toward strategies that have already demonstrated significant benefits. These include balance training, resistance exercises, and personalized fall prevention programs that combine approaches such as exercise, hazard assessment, and education based on an individual’s specific risk factors.